Kelley Anne Hudson, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

302823 Issued in MN

Practice address

1956 Feronia Ave
Saint Paul, MN 55104-3548

Phone

(651) 493-6658

NPI assigned

Feb 21, 2017

Last updated

Feb 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelley Anne Johnson Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optimal Brain MN PLLCGroup PAC ID 6709317787, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optimal Brain MN, PLLC

  • Clinical Psychologist
  • Oakdale, MN
  • NPI 1609614957
  Medicare reassignment Care Compare group NPD
• Integrative Health, LLC

  • Multi-Specialty Clinic/Center
  • Oakdale, MN
  • NPI 1396314654
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1558800748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2739 RUSSELL AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554111064",
            "telephone_number": "763-438-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1956 FERONIA AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043548",
            "telephone_number": "651-493-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "KELLEY",
        "middle_name": "ANNE",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "JOHNSON",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kalli Jo Hubin, B.A.
• Gabrielle Noelle Hubinger
• Christina Huch, L.AC.
• Nancy Hudgins, MA, LPC
• Hudson Physicians, S.C.
• Mark J Hudson, MD
• Robbin Michshell Hudson, RN
• Tina Lashae Hudson
• Jacquelyn A Huebsch, ANP
• Ross M Huelster, PA-C

• Addiction (Substance Use Disorder) Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.